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General NPI Number Information
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NPI Number | 1659160745
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Entity Type | Organization
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Legal Business Name | MEDWELL PLUS, LLC
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Dates
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Enumeration Date | 05/05/2025
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Last Update Date | 05/05/2025
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Provider Practice Location Address
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Address Line | 1204C N 2ND ST
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City | BOONEVILLE
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State | MS
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Zip | 38829-1013
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Country | US
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Telephone | 662-720-6007
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Fax | 662-966-0007
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Provider Business Mailing Address
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Address Line | 1204C N 2ND ST
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City | BOONEVILLE
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State | MS
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Zip | 38829-1013
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Country | US
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Telephone | 662-720-6007
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Fax | 662-966-0007
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | MS. MELODY ANNE COLE
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Credential | FNP-BC
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Telephone | 662-720-6007
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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